| Choice | Drug | Dosage |
|---|---|---|
| 1st choice | Hydrogen peroxide cream 1% (Crystacide®) | Dose: |
| or | ||
| Silver sulfadiazine 1% cream (Flamazine®) | Dose: Burns: apply daily or more frequently if very extensive Leg ulcers or pressure sores: apply daily or on alternative days Fingertip injuries: apply every 2-3 days | |
| For MRSA only | Mupirocin 2% cream/ ointment (Bactroban®)15g | Dose: |
Prescribing Notes
- To avoid the development of resistance, topical mupirocin or fusidic acid should only be used for localised infections and not be used for longer than 7 days. Local microbiology advice should be sought before using in hospital.
- For acute impetigo, topical antibiotics should be reserved for very localised lesions. Small areas of the skin may be treated by short-term topical application of fusidic acid three to four times a day.
- If impetigo is extensive or long-standing, an oral antibacterial such as flucloxacillin (or erythromycin in penicillin allergic) should be used.
- Hydrogen peroxide cream (Crystacide®) may be used as an alternative agent to topical antibiotics.
- Silver sulfadiazine cream is used for infected burns and ulcers.
- Topical antibacterials should be avoided in leg ulcers unless used for short courses for defined infections; treatment of bacterial colonization is generally inappropriate.
- Metronidazole gel is helpful for secondary infections of fungating tumours.
Caution
- Mupirocin (Bactroban®) ointment should not be used in conditions where absorption of large quantities of polyethylene glycol is possible, especially if there is evidence of moderate or severe renal impairment.